2019 Adventure WILD Winter & Spring Break Camp Registration

Camper and Parent Information

Camper Information
Parent or Guardian Information:
Additional Parent or Guardian Information:

Emergency Contact

Parents or guardians will always be the first contact made in case of an emergency. The following individuals are authorized to act on behalf of parent(s)/guardian(s) in the case that they cannot be reached:

Authorized Pick-Up People

Parents/guardians and emergency contacts listed above are automatically authorized to pick-up, unless otherwise stated. If anyone else may be picking up your camper, please fill out this form. You will be able to edit this form until 3 days prior to the camp start date by accessing your confirmation email.

I understand that if anyone other than parent, guardian, or emergency contact is to pick up my camper, they need to be listed on the Pick-Up Authorization Form above. I understand that I will be able to edit this form after submission by accessing my confirmation email. *
Additional Information
How did you hear about us? (choose all that apply - at least one required)

Are you or anyone in your family a Mazama member? *

Additional Camper Information

Please describe any allergies or reactions to the following. Please include dietary restrictions, even if it is not an allergy.
Please note whether or not medication will need to be taken during camp hours. *
Note: All medication must be turned in to Adventure WILD staff at the beginning of each camp day or session. All medicine must be in the original container and labeled with the camper's name. Medication cannot be administered or dispensed by Adventure WILD staff. Campers must be able to take their own medication. However, staff can carry medications and help children remember to take them. 
Is the participant covered by family health insurance or Medicare? *
I give my permission for Adventure WILD staff to provide first aid for the child named above and to take the appropriate measures including contacting the Emergency Medical System and arranging for transportation to the nearest medical facility. I agree to indemnify and hold Adventure WILD and its parent companies, its officers and employees, harmless from claims of losses for any bodily injury of property damage, which occurs or is alleged to have occurred as a result of negligence of participant. *
Parent/Guardian Commitment:
I understand it is the camper's responsibility to participate in the whole camp program, including work, play, values sharing, and working together. I understand and support the commitment that the camper has made above. I accept that failure to adhere to camp policies is cause for camper's dismissal from camp with no refund of fees. I am aware that camp activities involve a degree of risk and approve of opportunities the camper will have to participate in them.
General Waiver/Release:
I hereby accept any and all responsibility for, and assume the risk of any and all injury or damage to my person or dependent children that might arise directly or indirectly as a result of, and or participation in Adventure WILD and Mazamas program areas or activities. I hereby express release, discharge and hold harmless from any liability, losses, causes of action, expenses and/or claims for damages whatsoever the Adventure WILD and Mazamas, the various branches and subdivisions thereof, and all employees and volunteers in their capacities as representatives of the Adventure WILD and Mazamas, expressly including but not limited to the Board of Managers of Mazamas, except for injuries caused intentionally or by willful misconduct by such parties. I certify that I am familiar with the contents of this release, that I have read and understand the same, and it is my intention by signing this release that the same be binding not only on me, but my heirs, administrators, executors, successors and assigns. I understand the risks involved in participation of outdoor recreational activities, and I am fully aware that there may be hazards and risks unknown to me, and I and/or my dependent children are physically able to participate in all the program areas offered at Adventure WILD Day Camp. I understand that I am responsible to pay my own medical and emergency expenses in the event of accident or illness regardless of whether I have authorized such expense. Furthermore, I am fully aware that the risks, known and unknown can cause injury, property damage, illness, mental or emotional trauma, disability or death. This waiver and release will be construed broadly to provide a waiver and release to the maximum extent permissible under applicable law. Any provisions found to be void or unenforceable shall be modified or deleted to the minimum extent necessary to make them enforceable, and shall not effect the enforceability of any other provisions.
Acknowledgement and Assumption of Risk, Release and Indemnification:
The Mazamas has existed as an outdoor organization for over a century. Mazama activity leaders are
volunteers and not professional guides. Accidents resulting in serious injury or death do occur in
outdoor activities. Mountaineering, rock climbing, ice climbing, hiking, mountain biking, skiing and
other outdoor activities are dangerous. I accept the risks of such activities, and I undertake them on
my own responsibility.
Before participating on a Mazama activity, I will know and understand the activity and the hazards and will judge for myself if I have the skills and knowledge to safely participate. If I do go, I will remain
constantly alert for dangers to myself and others and will fully participate as a safe team member. In consideration of permission to participate extended to me, I hereby agree, without limitation, to hold
harmless, indemnify and discharge the Mazamas, (by which reference I intend to include) their agents,
officers, employees and the trip leaders of any and all liability, claims and causes of action that may arise
on account of any negligent act or failure to act during my participation in or traveling to or from any
Mazama activity, and by specific example to include without limitation:
1. I acknowledge that mountaineering, rock climbing, ice climbing, hiking, mountain biking, skiing
and other outdoor activities entail known and unanticipated risks that may result in physical or
emotional trauma, injury, paralysis or death; or damage to my property or that of third parties.
Although the Mazamas has taken reasonable steps to provide me with adequate training,
equipment and qualified volunteers, I understand that such risks simply cannot be eliminated
without jeopardizing the essential qualities of the activity.
The risks include but are not limited to: the hazards of traveling in uneven mountainous terrain
and slips and falls, hazardous driving conditions; being struck by rock fall, icefall, or other objects
dislodged or thrown from above; the use of climbing ropes and equipment; the forces of nature
including lightning, weather changes, whiteout conditions and avalanche; the risk of falling off of
a rock, mountain or into a crevasse; of getting lost or benighted; the risk of exposure to insect
bites; the risk of altitude and cold including hypothermia, frostbite, acute mountain sickness,
cerebral and pulmonary edema; the risk of falling off a trail, crashing while biking or skiing and
equipment failure, negligent acts of party members, my own inadequate physical condition; and
the physical exertion associated with this activity.
The Mazamas strives for safety but is not infallible and risk is inherent in this activity. The
Mazamas may be unaware of my fitness or ability or that of other participants. The Mazamas may
misjudge the weather or other environmental conditions. The Mazamas may give incomplete
warnings or instructions, and equipment being used may malfunction. I acknowledge that
engaging in this activity may require a degree of skill and knowledge different from other
activities and that I have responsibilities as a participant to insure my own safety. I acknowledge
that the Mazamas has been available to more fully explain to me the nature and physical demands
of this activity and the risks, hazards, and dangers associated with it.
2. I expressly agree and promise to accept and assume all the risks of this activity. My
participation in this activity is purely voluntary, and I elect to participate in spite of the risks of
injury and death known and unknown.
3. I hereby voluntarily release, forever discharge and agree to indemnify and hold harmless the
Mazamas from any and all claims, demands or causes of action that are in any way connected
with my participation in this activity or my use of Mazama equipment or facilities including any
such claims that allege negligent acts or omissions of the Mazamas.
4. It is the purpose and intention of this agreement to prevent me or anyone on my behalf from
asserting a claim against the Mazamas for its negligence. I agree to this and acknowledge that
purpose. Should the Mazamas or anyone acting on its behalf be required to incur attorney’s fees
and costs to enforce this agreement or to defend a claim made by me or on my behalf or that of
my estate, I agree to indemnify and hold them harmless of all such fees and costs.
5. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while
participating in this activity, and, if I do not, that I agree to bear the costs of such injury or
damage myself. I further certify that I am willing to assume the risks of any medical or physical
conditions I may have. In case of accident, illness or other incapacity, I understand that I must pay
my own medical and evacuation expenses, whether or not authorized by me.
6. I understand that the Mazamas may contract with independent contractors to provide services on
the trip, including transportation, travel services and guide services. I understand that the
Mazamas has no control over and accepts no responsibility for the actions of any independent
contractor involved in providing services on the trip/activity. I agree not to make a claim against
the Mazamas regarding its selection of independent contractors or their performance or
negligence of such independent contractors.
The laws of the State of Oregon will govern this agreement, and I consent to the jurisdiction and venue
of the federal and state courts sitting in Portland, Oregon. If there is a dispute between the parties relating
to this document, the party substantially prevailing will be entitled to recover all costs and expenses of
any subsequent proceedings (including trial, appellate, and arbitration proceedings), including the
attorney fees incurred therein.
By signing this document, I acknowledge that if anyone is hurt or property is damaged during my
participation in this activity, I have waived my right to maintain a lawsuit against the Mazamas on
the basis of any claim from which I have released them herein. I have had sufficient opportunity to read
this entire document. If any part of this agreement is deemed unenforceable, the remaining parts shall be
given full affect to the extent possible. I have read both pages of this agreement, I understand this
agreement and I agree to be bound by its terms.

Parent’s or Guardian’s Indemnification
In consideration of minor listed on the above registration form, hereby refered to as "Minor", being
permitted by the Mazamas to participate in its activity and to use its equipment and facilities, as the
parent or guardian of minor, I hereby give my permission for minor to participate in the foregoing and
further agree, individually and on behalf of minor, to the terms of the above and to indemnify and hold
harmless the Mazamas from any and all claims that are brought by or on behalf of the minor, which are
in any way connected with such participation or use by minor.

Photo/Video Release

I grant Adventure WILD and Mazamas the right to unrestricted permission to copyright and/or use and/or publish photos, videos, and any other media taken of applicant for promotional purposes for itself and affiliates. 

I agree to the photo/video release *
I have read the WAIVER and RELEASE; I understand it and sign it voluntarily. *


PLEASE NOTE: If your child is enrolling in more than one Adventure WILD camp day or week please register them for all camps at once. Any additional registrations will be deleted.

WILD Day: Super Swimmers - Saturday, January 26th, 9:00am-3:00pm (Grades 1-3) - $50
(0 remaining)
WILD Day: Funky Flyers - Sunday, February 24th, 9:00am-3:00pm (Grades K-1) - $50
(0 remaining)
WILD Day: Garden Guardians - Monday, April 8th, 9:00am-5:00pm (Grades 3-5) - $65
(9 remaining)
WILD Day: Garden Guardians Before Care - Monday, April 8th, 7:30am-9:00am ($10)
(10 remaining)
WILD Day: Garden Guardians After Care - Monday, April 8th, 5:00pm-6:00pm ($8)
(9 remaining)
Adventure WILD Spring Break Camp (March 25th-29th) is FULL
Adventure WILD Spring Break Camp: Before Care
(8 remaining)
(8 remaining)
(8 remaining)
(9 remaining)
(9 remaining)
Adventure WILD Spring Break Camp: After Care
(9 remaining)
(6 remaining)
(8 remaining)
(9 remaining)
(9 remaining)
Is the camp you would like to register for full? Click here to be added to the waitlist
Current Total:
Clicking Continue below will take you to a secure payment form on Authorize.net. Please do not use your back button or refresh the page, or your registration information will be lost. If you have payment questions or concerns, please contact the Mazamas at 503-227-2345 (office hours 11-7, M-Th; 10-2 F) or e-mail kelsey@mazamas.org.


Cancellations & Refunds

Adventure WILD reserves the right to cancel or combine classes that are below the minimum participant requirement. Should cancellations occur, Adventure WILD's staff will contact the participant's family about alternative classes. 

Cancellations made for Winter WILD Days prior to two weeks before the start date of the camp will result in a $10 cancellation fee, with the remainder refunded. 

Cancellations made for Adventure WILD Spring Break Camp prior to two weeks before the start date of the camp will result in a $50 cancellation fee, with the remainder refunded.

Cancellations made for any camp within two weeks of the camp start date receive no refund, with the following exceptions:

Short-term illness or injury: If a short-term illness or injury prevents the camper from attending the scheduled camp, the client may use the cost of the camp as a credit toward another Mazama WILD Camp during 2019 only, for a camp transfer fee of $35 + difference in camp cost.

Long-term illness or injury: Cancellations for any camp made within two weeks of camp start date due to long-term illness/injury must be accompanied by a doctor's note for a $50 cancellation fee (Adventure WILD Spring Break Camp) or $10 cancellation fee (per Winter WILD Day). A doctor's note must be received before a refund will be issued.


Please contact the Camp Manager at 971-808-2267. if your child will be absent. There will be no make-up classes for any camp programs. Absences will not be refunded unless the entire enrollment is cancelled more than two weeks before the session has begun.

Curriculum Changes

Due to the varying mix of camper ages/needs each week or other unanticipated events, the daily or weekly curriculum outlined on the Adventure WILD website may be adjusted as deemed appropriate by the Camp Manager.

Before & After Care and Late Pick-Up Policy 

Campers that are not enrolled in before care may not be signed in until 8:45am. All campers that have not been signed out by 5:10pm daily will be signed into after care, and parent/guardian will be charged accordingly. Parents/guardians of campers that have not been signed out by 6:00pm daily will be charged $2 per minute for late pick-up.

I have read and understand the above Camp Policies. *